Machine Learning Models for Predicting Mortality in Patients with Cirrhosis and Acute Upper Gastrointestinal Bleeding at an Emergency Department: A Retrospective Cohort Study

Shih-Chien Tsai; Ching-Heng Lin; Cheng-C J Chu; Hsiang-Yun Lo; Chip-Jin Ng; Chun-Chuan Hsu; Shou-Yen Chen

doi:10.3390/diagnostics14171919

Machine Learning Models for Predicting Mortality in Patients with Cirrhosis and Acute Upper Gastrointestinal Bleeding at an Emergency Department: A Retrospective Cohort Study

Diagnostics (Basel). 2024 Aug 30;14(17):1919. doi: 10.3390/diagnostics14171919.

Authors

Shih-Chien Tsai¹, Ching-Heng Lin^{2

3}, Cheng-C J Chu², Hsiang-Yun Lo¹, Chip-Jin Ng¹, Chun-Chuan Hsu¹, Shou-Yen Chen^{1

4}

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 333, Taiwan.
² Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
³ Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan 333, Taiwan.
⁴ Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan 333, Taiwan.

Abstract

Background: Cirrhosis is a major global cause of mortality, and upper gastrointestinal (GI) bleeding significantly increases the mortality risk in these patients. Although scoring systems such as the Child-Pugh score and the Model for End-stage Liver Disease evaluate the severity of cirrhosis, none of these systems specifically target the risk of mortality in patients with upper GI bleeding. In this study, we constructed machine learning (ML) models for predicting mortality in patients with cirrhosis and upper GI bleeding, particularly in emergency settings, to achieve early intervention and improve outcomes.

Methods: In this retrospective study, we analyzed the electronic health records of adult patients with cirrhosis who presented at an emergency department (ED) with GI bleeding between 2001 and 2019. Data were divided into training and testing sets at a ratio of 90:10. The ability of three ML models-a linear regression model, an XGBoost (XGB) model, and a three-layer neural network model-to predict mortality in the patients was evaluated.

Results: A total of 16,025 patients with cirrhosis and 32,826 ED visits for upper GI bleeding were included in the study. The in-hospital and ED mortality rates were 11.2% and 2.2%, respectively. The XGB model exhibited the highest performance in predicting both in-hospital and ED mortality (area under the receiver operating characteristic curve: 0.866 and 0.861, respectively). International normalized ratio, renal function, red blood cell distribution width, age, and white blood cell count were the strongest predictors in all the ML models. The median ED length of stay for the ED mortality group was 17.54 h (7.16-40.01 h).

Conclusions: ML models can be used to predict mortality in patients with cirrhosis and upper GI bleeding. Of the three models, the XGB model exhibits the highest performance. Further research is required to determine the actual efficacy of our ML models in clinical settings.

Keywords: cirrhosis; emergency department; gastrointestinal bleeding; machine learning; mortality.

Grants and funding

This research received no funding.